Checkbox *

Check box to agree statement is true.

I acknowledge that I will truthfully represent, with ID, to the tattoo artist, associates, agents and representatives of Downtown Tattoo that I am over eighteen (18) years of age.

I acknowledge that the obtaining of my tattoo is my choice alone and I consent to the application of the tattoo and to any actions or conduct of the associates, agents or representatives of Downtown Tattoo that are reasonable and necessary to perform the tattoo procedure.

I acknowledge that tattooing is a permanent change to my appearance and that no representations have been made to me as to the ability to later change, alter or remove my tattoo.

I acknowledge that variations in color and design may exist between any tattoos as selected by me and as ultimately applied to my body.

I acknowledge that I am aware that tattoo inks, dyes, and pigments have not been approved by the federal Food and Drug Administration and that the health consequences of using these products are unknown.

I acknowledge it is not reasonably possible for the tattoo artist, associates, agents and representatives of Downtown Tattoo to determine whether I might have an allergic reaction to the dyes, pigments, or processes used in my tattoo and I agree to accept that such risks are possible.

I acknowledge receipt of written instructions advising me of proper care of my tattoo and recognize the absolute necessity of following those written instructions.

I acknowledge that infection is always possible as a result of obtaining a tattoo particularly in that event that I do not take proper care of my tattoo.

I do not have acne, freckles, moles, sunburn, or have ever had a herpes infection in the area to be tattooed that might be agitated by the tattoo process (healing excluded).

I am not under the influence of alcohol or drugs.

I agree to release and forever discharge and forever hold harmless Downtown Tattoo and its tattoo artist, associates, agents officers and shareholders from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo or the procedures and conduct used to apply my tattoo and any and all tattoos applied by Downtown Tattoo and its tattoo artist, associates, agents and representatives in the future.

I have looked over my design, checked the spelling if applicable, and give my full consent to the application of my tattoo.

Do you have any additional allergies to items such as metals, soaps, cosmetics or alcohol? *

Yes

No

Are you currently on any medications that might affect the healing of the tattoo you wish to receive? *

Yes

No

Do you have any other medical or skin conditions that may affect the outcome of your procedure? *

Yes

No

Do you have any cardiac valve disease? *

Yes

No

Are you currently pregnant? *

Yes

No

Notice *

·Clients who back out of the procedure last minute may be subjected to a $20 setup fee, depending upon the situation. ·All tattoos are done with industry-standard inks. Some people have been known to experience allergic reactions to certain pigments, particularly those containing red pigments. Consult with your tattoo artist if you have any questions or concerns.

I understand

I have been fully informed of the risks of tattooing including but not limited to infection, scarring, difficulties in detecting melanoma, and allergic reactions to tattoo pigment, latex gloves, and antibiotics. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with tattoo application and I assume any and all risks that may arise from tattooing. *

I still wish to proceed

Name *

First Name

Last Name

Date of Birth *

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Emergency contact (Name and phone #) *

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Today's Date *

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